Monumental Medicaid vote set for today

The biggest Michigan political showdown of the year takes shape today when the state Senate’s long-delayed vote on expanding Medicaid health care for 470,000 “working poor” comes to a head.

A Senate panel has spent the summer analyzing the pros and cons of the issue -- and toughening up eligibility standards featured in a previously approved House bill -- but the resulting vote today by the Republican-dominated, 38-member Senate remains up in the air.

In fact, the prospect of a bipartisan 19-19 vote, with the tie broken by Lt. Gov. Brian Calley, appears to be an increasing likelihood as the clock ticks down.

State Sen. Jack Brandenburg, a Harrison Township Republican, and tea party groups across the state, including the Romeo Area Tea Party, have spent the past 24 hours pushing for a “no” vote on a bill that they view as an endorsement of President Barack Obama’s health care reforms.

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The vote has clearly divided the Michigan GOP, with Senate Majority Leader Randy Richardville leading the way toward approval while Brandenburg, normally a staunch Richardville ally, calling the Medicaid legislation “un-Republican” and irresponsible.

“This is a massive expansion of government,” Brandenburg said.

Gov. Rick Snyder and other supporters of the bill -- a contingent that includes virtually the entire Michigan medical community -- emphasize that expanding Medicaid eligibility would end the “hidden tax” of up to $1,000 per person created by the uninsured going to emergency rooms for health care.

The Obamacare plan, which has already been rejected in more than two dozen states, centers on making Medicaid coverage available to those living at up to 133 percent of the federal poverty level -- a $26,500 annual income for a family of three. It would save the state money, according to Snyder, by providing basic preventative and “wellness” care for those who lack insurance.

The federal government will pay 100 percent of the cost of this health care expansion through 2017 and will gradually reduce that reimbursement to 90 percent by 2020.

Tea party groups who have rallied in recent days to provide 11th-hour pressure on key senators assert that the bill represents “crony capitalism” by providing a revenue windfall to hospitals.

One of the most active tea party organizations in the state, the Romeo Area Tea Party, put out a statement telegraphing their wrath if the main bill passes:

“It is truly a slap in the face to all of us who voted for these politicians, believing what they said about promising to fight Obamacare and reduce the size of government. They call it politics, we call it lying and betrayal. The negative effects of this bill passing will reverberate for decades to come.”

In a TV interview over the weekend, Calley, a tea party target, said he is reluctantly ready to cast the deciding vote in favor of a larger Medicaid program funded by Washington. Conservatives who embrace fiscal responsibility, the lieutenant governor said, must recognize that rejecting the proposal and sending the working poor to the online Obamacare insurance marketplace will cost an estimated $7,800 per person annually in federal subsidies, while Medicaid enrollment’s price tag would be $4,200 per person.

But Brandenburg and other opposition GOP senators say that they not only object to Obamacare, they predict that the entire system of funding coverage for the nation’s uninsured will fall apart shortly.

“I think the governor is asking us to play a card we don’t want to play,” said Brandenburg.

Meanwhile, the mental health department directors of Wayne Oakland and Macomb counties wrote an opinion piece over the weekend that said the gaping hole in Michigan’s current health care system -- a lack of coverage for mental health and substance abuse disorders for the poor -- would be closed by the Medicaid expansion plan.

The bill before the Senate represents “sensible, public policy to tap federal funds already set aside to expand preventive and life-saving health care under Medicaid,” according to John Kinch, director of the Macomb County Community Mental Health Department, Tom Watkins the new CEO of Detroit/Wayne County Community Mental Health, and Jeff Brown, CEO of Oakland County CMH.

Brandenburg, the Senate Majority Whip who keeps track of the GOP votes on each piece of legislation, said all 12 Senate Democrats will vote for the main bill but he believes the overwhelming caucus of 26 Republicans remains short of the seven votes needed to create that 19-19 tie.